Infertility Management – Recent Advancement

motherInfertility is defined as a failure to conceive within one or more years of regular unprotected coitus.

 

Assisted Reproductive Technology (ART):

                        ART encompasses all the procedures that assist the process of reproduction by retriving  oocytes from the ovary or sperm from the testis or epididymis (or) It refers to any fertility treatments in which the gametes (sperm & eggs) are manipulated.

Different methods of ART:

IUI            :- Intra uterine insemination

IVF – ET  :- In vitro fertilization & embryo transfer

GIFT        :- Gamete intra – fallopian transfer

ZIFT         :- Zygote intra – fallopian transfer

POST      :- Peritoneal oocyte & sperm transfer

SUZI       :- Sub zonal insemination

ICSI        :- Intra – cytoplasmic sperm injection/insemination

Methods of sperm recovery :

TESE       : Testicular sperm extraction

MESA    : Micro surgical epididymal sperm aspiration

PESA     : Percutaneous epididymal sperm aspiration

 

Indications :

                           The common indications for ART procedures includes the following ;

♠        Abnormal  fallopian tubes : blocked tubes (or) absent tubes (surgical removal)

♠        Endometriosis adversely affecting tubo – ovarian pick up function

♠        Idiopathic (or) unexplianed infertility

♠        Male sub fertility

♠        Immunologic infertility

♠        Failure of ovulation – donar ovum

INVESTIGATION  PRIOR TO  ART :

¨     Semen FSH on days 3 of cycle , FSH > 25 ml U/ml indicates poor prognosis.

¨     Semen oestradiol on day 3 of cycle. Semen oestradiol > 75pg/ml indicates poor prognosis.

¨     Maternal age > 40 yrs. Success rates drop. Prior to considering ART, asses “ovarian reserve”.

¨     Test for ovarian reserve :This is indicated in women > 35yrs of age, smokers, presence of only one ovary & in explained infertility.

(It involves standard day 3 laboratory tests as mentioned above, along with administration of 100mg CC from day 5 to 9, repeat FSH on day 10. FSH values must be the same as on day 3 of the cycle.

¨     Serologic evidence of chlamydial infection is associated with reduced birth rates & increased perinatal loss.

¨     Enhanced sperm penetration test using test – yolk buffer.

¨     Testing both partners for anti sperm antibiotes.

¨     Asses uterine cavity – Hystero salpingography / hysteroscopy / trans vaginal sonography.

¨     Complete seminogram & treatment of male partner prior to ART procedure.

¨     Diagnostic laparoscopy to assess tubal patency & treat any subtle causes of infertility present such as lysis of adhesions, treatment of endometriosis, etc.

 

Types of ART procedure in practice:

 

1. Intra uterine insemination (IUI)

             

2.In Vitro Fertilization And Embryo Transfer (IVF-ET)

 

3.Gamete Intra – Fallopian Transfer (GIFT)

 

4. Zygote Intra – Fallopian Transfer (ZIFT)

 

5.Intra – Cytoplasmic Sperm Injection/Insemination (ICSI)

 

6.Sub Zonal Insemination (SUZI) Micro Assisted Fertilization (MAF)

 

7.Micro Surgical Epididymal Sperm – Testicular Aspiration and Biopsy

 

8. Ovum donation

 

 9. Surrugacy & Posthumas Reproduction 

 

HEALTH HAZARDS OF ART :-

♠       Mostly not associated with risk of fetal hazards/congenital anomalies.

♠       Increased number of pregnancy loss, multiple pregnancy, ectopic pregnancy, perinatal mortality & morbidity.

♠       Ovarian hyper stimulation syndrome is a rare but known health risk.

♠       Psychology stress & anxiety of the couple are severe , specially when there is failure in the treatment or with a pregnancy loss.

→ Inspite of excellent advances in field of infertility management, expectations are not fulfilled &  Adoption I an alternative for many couples.